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I have seen a new trend with people calling me - and quite frankly, it is disturbing. Someone gets in a crash. They call the other party's insurance company and report a claim. They get transferred to an adjuster. After a few questions, the adjuster says something along the lines of "We are sorry to hear that. You should go to the doctor. They can treat you up to 10 times."

So they go. And they treat 10 times. But you know what? They are still hurt. But they stop treating. The adjuster makes them some ridiculously low offer. They don't like it and then they call an attorney. By then, hopefully we can still help them.

The problem with this is simple: an adjuster should not be dictating your treatment. Just like I won't dictate a client's treatment, I leave that to the doctor. I figure I went to law school, not medical school. I need to let the doctors tell my clients what treatment they need, how often, etc....

The same applies to the adjuster. The adjuster, especially those front line adjusters, does not have a medical degree. They do know how to read a script, tell you what you are supposed to hear, and try to resolve the claim. Heck, some insurance companies are now offering you money, sent via electronic transfer to your account, if you settle in the first few days.

Do NOT let an adjuster dictate your treatment. Go to the doctor. Listen to the doctor's advice. And make sure you make a full recovery! Oh, and talk to an attorney so you know your rights.

Question: I was involved in a car crash. I have medical insurance. Am I responsible to pay these bills back when I settle my case?

Answer: This is based on two recent cases I have had! I wish it wasn't, but two clients hired me on cases because the other party's insurance company told them lies about their bills. In the first case, my client was told he would not have to reimburse Rawlings, who was collecting on behalf of Blue Shield. In the second case, my client was told that she would be personally liable to Kaiser if she did not settle the case. The one thing these two cases have in common: both people were lied to by adjusters. (I don't like using that word, but it is the only word that fits!)

Let's start with the easy scenario. There are a ton of different scenarios I can give you. But, to keep things simple, I am going to give you the three most common: you have no health insurance, you are insured by a health plan that is not Kaiser and you are insured by Kaiser.

You are involved a motor vehicle collision and you do not have insurance. You incur bills for your treatment. You are personally liable for these bills and MUST pay them back. You MAY be able to negotiate them, but your creditors are coming after you - one way or another. So if you settle your case, you pay them back. If you don't settle your case, they sue you. If you do not pay them back, they will sue you for the money. Easy, right?

Now, we can make it harder. You have insurance with Blue Shield or Blue Cross or Anthem or Aetna or CIGNA or.......... well, you get the idea. They pay your hospital bill and doctor's bills. You go to settle your case. You get paid. Generally, they are entitled to any money you recover from a third party (3rd party). A third party is the other person - or the other person's insurance company. So when you settle your case, you have to pay them back. Now, sometimes you can pay them back less then they paid you. But, if it is an ERISA plan, in other words, paid for by your employer, you generally have to pay them back in full.

What about if you have Kaiser? I know, Kaiser doesn't bill you. Right. But, wrong too. When you are injured as a result of someone else's negligence, such as a slip and fall or car accident, Kaiser hires a company called Equian (it used to be called Trover and before that, Healthcare Recoveries). Equian obtains your records and prepares a bill. They send that bill to you or to your attorney. You then have to pay them back. But, unlike the ERISA plans discussed above, Kaiser will typically reduce the amount you have to pay back. So, that is the good news.

The moral of the story: do NOT trust the adjuster. Nope. Never. Do not do it. The adjuster is going to tell you whatever they need to tell you so you will settle your case. Do not listen to them. If you are unsure about whether you have to pay back your medical insurance or your medical providers, then talk to an attorney. Get some actual advice from someone you trust and someone who is on your side!

Let me relate a real story about why you should never trust an insurance company. This is for a case I am currently working on. As background, my client was rear ended in a car accident by an unlicensed, uninsured driver.

A client of mine was involved in a car crash. He went to the ER. His health insurance paid $4,000 of a $10,000 bill. His own insurance company, GEICO, offered to settle the case with him and told him it was based on $4,000 in medical bills.

The problem? The client is still on the hook for the other $6,000. This is called balance billing and it is legal in California. In other words, you may get stuck with a balance for emergency room treatment even after your insurance company pays the bill.

The adjuster knew this, admitted to me that he knew it, and had no problem with the fact that he lied to my client/their insured. Yes, their own customer they lied to and had no issue with it. The client called me for a consultation. I helped him through this mess and we will get his case resolved.

The moral of the story: do not trust insurance companies. I don't care if it is a "small crash" or a large crash, you need to at least consult with an attorney about your car crash.

I have been saying this for 12 years while running my own law firm. Prior to that, I said it for almost a decade working for insurance companies. And yet, despite what I say, people do not listen. So let's try it again - there is NO formula for settling a personal injury case, whether it is a car accident, slip and fall or any other type of injury.

First, despite what some adjuster might tell you, and what you will read on the internet, there is no secret formula or book that tells you what your case is worth. Insurance adjusters are big now in telling people that they have reviewed the information and their formula tells them that the case is worth a certain amount. Heck, I heard it yesterday! Trust me, juries do not use formulas when they evaluate cases and good personal injury attorneys do not use formulas either.

Each case has its own value and the insurance companies alleged "formula" is not accurate. If it was simple as multiplying your medical bills by a certain number, a lot of people say 3 times your medical bills, then there would be a lot of unemployed attorneys, on both sides, and a lot of unemployed adjusters. Think about the money insurance companies would save by firing their adjusters. And, make no mistake, insurance companies like saving money! There is no formula for settling a claim as every claim is different and every situation is different!

The adjuster will also try to talk you out of retaining an attorney. The adjuster will tell you that it does not increase the value of the case. That is complete garbage. An attorney with experience can help you maximize your recovery. In fact, a study by Allstate, and confirmed by other insurance companies, showed that people who hired an attorney recovered more money than someone who did not hire an attorney. In other words, hiring an attorney resulted in a larger net settlement for the injured party. (By the way, add in that you have less stress, don't have to talk to the adjuster, and don't have to worry about missing some deadline and it makes more sense.) They just don't want to publicize these studies!

Talk to an attorney and find out the real value of your case. Do not assume there is a formula, despite what you might read online!

The what of what? I typically hear people call it the statue of limitations. However, folks, it is not a statue. It is a statute, or a law. The statute of limitations tells you how long you have to sue someone for something. We don't want people to do something today and then be sued in 20 years. Witnesses forget things, evidence is destroyed, people move on with their lives. So we have this handy dandy law that limits how long you have to sue someone. Here is a shortcut. This does not provide every statute of limitations and you should talk to an attorney about YOUR specific facts. Do not rely on this as telling you what your statute of limitations is!

Medical malpractice actions: Three years from the date of injury or one year from the date of discovery of the injury, whichever occurs first.

Suits for libel or slander: One year.

Personal injury claims based on negligence: Two years.

Suits for injuries resulting from domestic violence: Three years from the last act of domestic violence.

Childhood sexual abuse: Eight years from the victim's 18th birthday or three years after the victim realizes that physical or psychological injury has resulted from childhood sexual abuse, no matter what the victim's age.

Property Damage: There is a three year time limit to file a lawsuit for property damage, from the date that the damage occurred.

Government Agency Claims: The claim filed against the government agency has a time limit of six months from the date of the incident.

The point of this is a simple reminder: do NOT wait to talk to an attorney if you have been injured. You could miss a deadline. For example, if you get in a car crash and you don't realize the other driver was working for the State or County, you could miss the six month government tort claim statute.

If you have any questions about a specific statute of limitations, talk to an attorney!

Of all the automobile insurance coverage that exists, Uninsured Motorist Coverage (UM) is THE MOST important coverage. (In California, uninsured motorist also acts as underinsured motorist coverage.)

Why is Uninsured Motorist Coverage so Important? If you buy UM coverage and a driver who has no insurance injures you, your insurance company will pay your damages up to the limit of your UM coverage. Since the other driver is uninsured, or underinsured, your insurance company “steps into the shoes” of the insurance the other party should have had and pays the claim. UM coverage also will pay you if you are the victim of a “hit and run” and the other driver is never caught. However, you must meet certain requirements, but this coverage can be very important. For example, if you are hit by a hit and run driver, you need to have the license plate number and a police report to have coverage under most policies.

Example: You are stopped and hit by a person who has no insurance. You are injured as a result of the collision. Your insurance company will pay you for your injuries since the other person did not have insurance.

UM also acts as Underinsured Coverage. If you get hit by someone who has less insurance than you, and your injuries are worth more than the other person’s insurance, your insurance company will pay you the amount of your claim up to the limits of yourcoverage.

Example: You are stopped and hit by a person who has a $15,000 policy. You are injured and your medical bills are $30,000. His insurance company will pay you the $15,000 and your insurance company will pay you the difference. However, they only pay you up to your limit. So if your limit is $25,000, you would only be paid $10,000 more.

Does this sound like something your insurance company has told you? Probably not.

Why aren’t they telling you this? Well, uninsured motorist coverage is relatively inexpensive to increase. Therefore the increase from a $30,000 insurance policy to a $100,000 policy generally will only cost you a few more dollars per policy. However the coverage is substantially greater, in this case, more than three times greater.

Why is this the most important insurance coverage you can have? Uninsured motorist and underinsured motorist protect YOU! Let me say that again: this insurance protects you. Let's say you are the sole income earner in your house. An uninsured motorist hits you and makes it so you can't work for 6 months. Your uninsured motorist coverage makes sure that you get compensated for your injuries. Why would you have $100,000 of protection for other people but only $15,000 or $25,000 for yourself? You wouldn't but because most people don't really understand this coverage, they make this mistake - constantly! And your agent doesn't tell you this!

Remember, about half of all drivers in California are uninsured. About another 25% are underinsured. So 3 out of every 4 drivers do not have enough insurance to compensate you if you are injured or your car is damaged in a crash. Your solution is uninsured motorist coverage.

I have come across quite a few total losses lately that are simply wrong. I would like to tell you that the values are wrong or that there is a dispute. But the last few that I have seen are wrong.

What do I mean by wrong? Let's say you have a Honda Accord. If the adjuster listed it as a Honda Civic, the total loss evaluation would be wrong. What if you had a Dodge Challenger and the adjuster put down a Ford Escort? That would be wrong as well.

These may seem like extreme examples. But, I have had quite a few similar examples recently. For example, my client had an Acura Integra Type R. The insurance adjuster evaluated it as an Acura Integra. Now, this isn't a trim line issue. For those of you who do not know what that means, trim lines are usually things like EX, LX, etc... after the type of car. Ford likes to use Limited, Eddie Bauer and other names.

But, with respect to the Integra, the regular Integra is a good car. The Type R is an even better car with significant upgrades in engine, steering, brakes and a few other bells and whistles. The Type R was also made in limited production.

When you get your total loss evaluation, make sure you review it closely so you can confirm that they are evaluating the right car with the right equipment on it!

I have recently had several clients pulled their insurance from their long time insurance company and placed it with a different company. Both clients were very dissatisfied with the service they received for the payment of their cars and their medical bills. By the way, that makes these first party claims, which means nothing to most people, but in English, it means that insurance companies should treat you better than if it was a third party claim. In other words this was their own insurance company screwing them.

In these situations, the insurer subsequently called to ask what they could do to keep the business. The clients told them that the poor customer service was the reason for the cancellations. So, if the insurers want to know what to do to keep their current clients, here are a few ideas:

Start treating people with respect.

Hire adjusters with a college degree. No disrespect to those without a college degree, but handling insurance claims requires a certain skill set that people learn in college. A lot of the skill needed is dealing with diverse people. You learn that in college.

Pay claims timely.

Don't nickel and dime your insureds on their claims. If you owe $2,500, pay $2,500 not $2,450.

Make fair and reasonable offers on total losses. Pay the fair market value of the car, not what some company tells you it is worth.

Get rid of your complex phone systems. It shouldn't take me entering 25 digits to get to someone. Seriously, try calling USAA on a claim and tell me what you want to do when you are done. I would rip out my hair - if it wasn't so short to begin with!

Start writing letters in plain English. People want to understand what you are saying. Four pages to say "We are investigating your claim" is overkill.

Don't ask what you can do AFTER someone leaves. Be proactive in keeping your customers happy.

Stop forcing your insureds to be sued because you don't want to settle a claim.

Stop hiding your tactics. In this day and age, there is enough information available that people see what you are doing. Don't hide it. Just be honest with people.

Now, I know some of these will never happen. Heck, most of these will never happen. But, some of these are common sense ideas. It would be nice to see insurers go back to trying to keep their own customers happy, at least.

People hear the term MIST claim and they do not know what it is. They do not know if their claim is a MIST claim. You are involved in a car accident and someone says MIST.

Do you even know what MIST means? Probably not. And don't worry, most attorneys do not know what it means either!

MIST cases are an acronym for:

MinimumImpactSoftTissue

The "minimum impact" part usually means there is less than $1,500 in damage to your car. This does vary by insurance company. Some will say less than $1,000 and some will say less than $2,000 or $2,500.

The "soft tissue" part means that you have what is commonly called whiplash. You have a neck and back injury. Simple enough. There is nothing broken and you do not have a closed head injury, or a concussion.

MIST cases are different from other cases. Insurance companies take these cases very seriously. They spend a lot of money defending them, investigating them and paying "expert witnesses" for their opinions. Insurance companies hate paying out on these. Your own insurance company will even fight you on an uninsured motorist MIST case.

So, what do you do? Hire an attorney who handles these - a lot. Or better yet, hire someone who actually teaches other attorneys how to handle them.

I have written a book for attorney on litigating MIST cases. If you have a MIST case, you should talk to someone who has experience in MIST cases.

I get a lot of calls in a month about property damage issues. The big ones are "How much do they owe for my car?" and "Why isn't there enough to pay for my repairs?"

First, property damage claims, especially if it is only property damage and their is no injury, are difficult to take as an attorney. If your repairs are $10,000 and I take a contingency fee on it, you end up with $7,000 - probably. Now you don't have enough to repair your car. So you aren't happy. Hence, most attorneys won't take a property damage only case.

Second, how much do they owe you? It depends. There are a few situations that come up:

a. Your car is repairable and you have collision coverage - your insurance company owes you to fix your car; b. Your car is a repairable and you have no collision coverage - if the other driver is at fault, they owe you to repair your car plus either a rental car or loss of use; c. Your car is a total loss and you have collision coverage - your insurance company owes you the fair market value of your car (note it is not the blue book value of your car); d. Your car is a total loss and you do not have collision coverage - if the other driver is at fault, they owe you the fair market value of your car plus either rental or loss of use.

So A and C are pretty clear. The problem comes with B and D. If you do not have collision coverage, you may be at the mercy of the other driver's insurance company. If that driver does not have enough insurance, you may not get paid in full for your car. The insurance company will only pay up to the property damage limits of the other driver. Hence, if you have $6,500 in damage and their limit is only $5,000, the most the insurance company will pay is $5,000. You will NOT be paid in full.

This is one reason you should carry collision on your car. It is possible that someone else could damage your car and you may not get paid in full for the repairs.

Of course, if you have any questions, you can call my office or email me for a free consultation.

DISCLAIMER

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This blog is made available by the lawyer publisher for educational purposes only as well as to give information and a general understanding of the law, not to provide specific legal advice. By using this blog site you understand that there is no attorney client relationship between you and the Blog publisher. The Blog should not be used as a substitute for competent legal advice from a licensed professional attorney in your state. Jonathan G. Stein, is licensed to practice law in the state of California only.
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